Good Evening

Dr Teoh Ming Keng

President

Asian Vascular Society &

Vascular Surgical Society (Singapore)

Distinguished Guests

Ladies and Gentlemen

It is my pleasure to join you this evening at the 5^th International Congress of the Asian Vascular Society. I would first like to congratulate the Vascular Surgical Society for organising this Congress. I would also like to extend a warm welcome to all participants, especially those who come from overseas and wish you a pleasant stay in Singapore.

Singapore is honoured to host this important congress which brings together many distinguished speakers and participants from the region. Even in the INTERNET age, such meetings remain highly relevant as they create the stimulating scientific environment for learning, exchange of ideas and experience and for networking and collaboration.

Vascular Surgery is a relatively young discipline in Singapore. Previously, the practice of vascular surgery was provided as part of cardiothoracic and general surgery. However, as vascular problems have become more common and important, there was a need for greater expertise and capabilities in this field. The first Vascular Unit in Singapore was established in the Department of General Surgery, Singapore General Hospital in 1994. Starting with only one consultant, today the unit has 4 consultants. In addition to this, 2 other vascular units have been set up in another 2 public hospitals – namely the Tan Tock Seng Hospital and Changi General Hospital to better meet the needs of the population.

Over the past few decades, vascular surgeons have acquired and mastered technical skills in the repair and reconstruction of blood vessels. Rapid advances in medical technology have also led to innovations in less invasive techniques in the diagnosis and treatment of vascular problems. For example, duplex ultrasound scanning is increasing being used for preliminary assessment of vascular conditions. Endovascular treatments such as the insertion of stents or grafts through the femoral arteries is now a feasible alternative to major open repair for selected patients with abdominal and aortic aneurysm, particularly those at higher risk such as the frail elderly.

It will be an exciting time for the participants as you come together at this congress to share experiences, knowledge and new innovations which may lead to better treatment and improved clinical outcome for patients.

With advances in medical technology, there is great potential for new treatment modalities with better clinical outcome. Although it is important that our local medical community keep up with these advances so that we continue to have high standard of health care in Singapore, we also have to be mindful not to cause an escalation of health care cost.

To address this issue, my Ministry established the Health Service Development Programme (HSDP) in 2001 as a funding mechanism to evaluate the development of new capabilities in our public health care system. With this source of funding, the public sector institutions are able to carry out pilot programmes in the use of cutting-edge medical technology, evaluation of advanced or experimental treatments.

One vascular surgery related project funded under this programme is the use of endovascular stenting for aortic aneurysms. At present, due to the high cost of the aortic stent graft of around $12,000 - $18,000, there are very few cases done per year. Those who can afford the graft are often not suitable for the procedure and those who are suitable or whose only hope is a stent, because they are unfit or unsuitable for open surgery, may not be able to afford the stent. This project provides funds of about $1.1 million over a 3 year period for subsidising the cost of the stent for needy patients, for whom the stent is medically indicated within the period of the funding. The programme would also allow our vascular surgeons to further develop their expertise and capabilities in this area over this period.

In Singapore, our aging population, high prevalence of diabetes, hypertension high cholesterol level and smoking are all risk factors for the development of peripheral arterial disease.

In year 2000 and 2001, there were 418 and 383 lower limb amputations respectively, due to vascular complications of diabetes. With an estimated 200-250,000 diabetics in the population, this gives a diabetic amputation rate of about 0.2%. Amputation of the lower limb not only causes significant handicap for the amputee but also poses a tremendous social and economic burden on their families.

The challenge is therefore to move beyond saving the life of patient to save their limbs and improve the quality of life of the patient.

In this aspect, my Ministry has supported another project under HSDP – Lower Extremity Amputation Prevention for Life Programme. This programme aims to :

About $1.4 million has been allocated for this programme. In this programme, the vascular surgeons need to work hand in hand with primary physicians, radiologists, and vascular technologists to achieve the best outcome for the patients.

To move the way ahead, it is not sufficient just to keep up with the latest development and perfect new skills. It is also important that the medical community carry out research to look into new opportunities and innovations to enable us to achieve further advances and progress. To this end, my Ministry has supported research projects related to vascular conditions with funding through the National Medical Research Council. Some of the ongoing research projects include perioperative deep vein thrombosis and abdominal aortic aneurysm. I hope that these researches can provide results for better understanding of the vascular disease pattern and pave the way for better treatment for the benefit of the patients.

In closing, let me wish all participants a successful and fruitful congress.

It is now my pleasure to declare the 5^th International Congress of the Asian Vascular Society open.

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